FORM 1023-EZ for KEYSTONE DIABETIC KIDS CAMP

Field Data
EIN 47-5053213
Case Number EO-2015281-000296
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KEYSTONE DIABETIC KIDS CAMP
Organization’s Mailing Address PO BOX 188
City BREINIGSVILLE
State PA
ZIP 18031
Accounting period End 12
Primary contact name DAVID SYNNAMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID SYNNAMON
PRESIDENT, DIRECTOR
1159 TUDOR DR
BREINIGSVILLE PA 18031

Officer/Director/Trustee Two

HEATHER L ARNOLD
SECRETARY, DIRECTOR
19 HIGHLAND DR
CAMP HILL PA 17011

Officer/Director/Trustee Three

NELSON THOMAS BURD JR
TREASURER, DIRECTOR
8075 SPRING RD
NEW BLOOMFIELD PA 17068

Officer/Director/Trustee Four

DON SPIDELL
DIRECTOR
143 GRAYSTONE DR
HUMMELSTOWN PA 17036

Officer/Director/Trustee Five

GORDON FULLER
DIRECTOR
226 VALLEY RD
MEDIA PA 19063

Organization’s website WWW.KDKC.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/2015
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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